The National Diabetes Audit (NDA) provides a comprehensive view of diabetes care in England and Wales and measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards. The 2017-18 report includes data on 3,398,470 people for the audit period 1 January 2017 to 31 March 2018.

**Key Findings**

**Achievement of the Treatment Targets (HbA1c, Blood Pressure, Cholesterol)**

Greater than 7 per cent improvements in HbA1c for Type 1 diabetes and blood pressure for Type 2 diabetes over the 6 year period 2012-13 to 2017-18.

People of working age and younger are almost half as likely to achieve treatment targets as their older counterparts.

**Annual Care Processes**

Urine albumin care process checks are completed less frequently. The lower levels of BMI recording that started in 2013-14 are unaltered.

Most other care processes remain well completed, though less frequently in Type 1 patients overall and in younger people with any type of diabetes.

**Variation**

All measurements showed marked geographical and between service variation.

**Structured Education**

Offers for structured education continue to improve but this is not yet matched by records of attendance.

**Learning Disability**

People with a learning disability who have Type 1 diabetes are more likely to receive their annual checks whilst those with Type 2 and other diabetes are less likely to receive them.

**Severe Mental Illness (SMI)**

People with Type 2 diabetes and SMI are less likely to receive their annual checks compared to their peers, especially for urine albumin and foot risk.

**Recommendations**

A collaborative approach is needed by GP services, CCGs/LHBs, structured education providers and specialist diabetes services to improve outcomes for people with diabetes:

- Develop and implement systems for GP practices that clarify who has attended patient education courses.
- People with diabetes should review their results for their practice, specialist service, CCG/LHB and where results are clearly worse than average.
- SMI care providers should be aware of the higher risks of Type 2 diabetes at younger age onset and in females.
- Seek new approaches to improving management for those overall doing worst.
- Type 2 diabetes care providers should work with people who have SMI to increase care process completion.
- Support people with a learning disability and Type 2 diabetes complete all their annual checks.
- Reduce variation. Every service and locality has results that are significantly poorer than their peers. Select priorities (e.g. bottom quartile results) for improvement; draw up and implement changes.

The full annual report and local level reports can be found at: [https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/report-1-care-processes-and-treatment-targets-2017-18-full-report](https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/report-1-care-processes-and-treatment-targets-2017-18-full-report)